Burnside’s IFBS Program: Evaluation findings and ‘debates’ ahead

1. Burnside’s IFBS Program:Evaluation findings and ‘debates’ ahead Sally Cowling and Anthea Jackson UnitingCare Burnside

2. Today’s presentation • Overview of Intensive Family Based Services (IFBS) and the Homebuilders model. • The North Carolina Family Assessment Scale (NCFAS). • Analysis of NCFAS ratings at intake and closure for Burnside’s IFBS 2004-09 by Dr Ray Kirk. • Importance of results in the context of KTS and Boston Consulting Group report on OOHC.

3. The Homebuilders Model • IFBS based on the Homebuilders model. • Designed to assist families at imminent risk of removal of their child(ren). • US model developed in 1974 (Washington) by the Institute for Family Development. • Underpins both Intensive Family Preservation Services (IFPS) and Intensive Family Reunification Services (IFRS).

4. Homebuilders: key program elements • Intervention at the crisis point • Treatment in the natural setting • Accessibility and responsiveness • Intensity • Low Caseloads • Research-based interventions • Flexibility

5. IFBS program characteristics • Immediate response within 24 hours. • Accessibility of staff 24/7. • Small caseloads (2 families). • Intensive interventions (up to 20 hours per week as needed). • Service delivery in the family’s home and community.

6. IFBS program characteristics • Usually short-term services (6 weeks) to be followed by other support services. • Hard and soft services delivered by same worker. • Recognises the importance of interaction between families and communities - helps families to forge those links. • Goal-oriented with “limited” objectives. • Focused on teaching skills.

7. Program fidelity matters • Adherence to program characteristics matters. • Major 2006 review of IFPS program outcomes sorted results by fidelity to Homebuilders model. • Programs which adhered closely to Homebuilders → significant decrease in OOHC placements and subsequent abuse and neglect. • Non-Homebuilders programs → no significant effect on either outcome.

8. A strong safety record: • Effective in breaking the cycle of abuse - 83% of families are still together 2 years post-intervention. • Working with CS to spell out bottom lines around care of children and work with parents. • Meeting with families in the home → more thorough assessment and opportunities for effective intervention.

9. Improvement in Family Functioning • NCFAS assessment tool developed for use in conjunction with IFPS. • Burnside and US evidence shows IFPS and IFBS → improvements in all domains of family functioning for majority of families. • Sally will review this evidence shortly.

10. What is NCFAS? • Measures family functioning at intake and case closure from worker’s perspective. • Includes 5 domains that look at family as a whole: • Environment • Parental capabilities • Family interactions • Family safety • Child well-being

11. Is NCFAS valid and reliable? • Yes! Both characteristics established in research reports available at: www.nfpn.org • Major Berkley University evaluation of 85 assessment instruments identified 7 as being the most appropriate and comprehensive. • NCFAS ranked first for child welfare settings. • Strengths-based focus and extensive testing with child welfare populations praised.

12. How does NCFAS help workers? • After assigning the intake domain ratings: • The lowest ratings are prioritised and addressed by setting goals and identifying services needed. • Family strengths identified in the assessment are employed to help the family learn new ways of working together successfully.

13. How does NCFAS help workers? • At case termination: • Worker assigns the closure ratings and compares them to the intake ratings. • Negative ratings or ratings in the moderate/serious problem range at closure indicate the need for additional services.

14. Why did Burnside choose NCFAS? • Assists workers in planning and making decisions. • Enables data collection → no. and % of families who have either positive or negative change. • Data enables: • Better targeting of families. • Identification of families in need of step-down. • Identification of areas for worker training.

15. Using NCFAS • It is essential that supervisors go over ratings with workers. • This ensures that the tool is being used effectively.

16. NCFAS reliability as used by Burnside workers • Reliability measured using Cronbach’s Alpha.

17. Overall environment (N = 110)

18. Overall Parental Capabilities (N=110)

19. Overall Family Interactions (N=110)

20. Overall Family Safety (N=110)

21. Overall Child Well-Being (N=110)

22. Increments of change: intake/closure (N=110)

23. Direction of Change: Negative/None/Positive (N=110)

24. Percentage of families at/above baseline at intake and closure (N=110)

25. US research findings • Peer-reviewed evaluations of IFPS show high success rates. Studies use a range of methods: • Control group studies. • Retrospective studies using event history analysis. • Comparison of high-fidelity v low-fidelity programs • NCFAS measures of family functioning (pre v post)

26. Kirk and Griffiths (2008) • Major study undertaken for North Carolina Dept. of Health and Human Services. • Based on a 5-year history of families served by IFPS program in North Carolina. • 2008: IFPS served 374 families with 769 children at imminent risk of removal. • After IFPS just 15 children (2%) were not living at home.

27. Kirk and Griffiths (2008) • 2008: placement prevention rate was 96% for families and 98% for individual children. • Over 5 years: comparable figures were 95% for families and 94% for individual children. • Over 5 years: IFPS significantly reduced the level of service required for children placed in OOHC. • In 2008, IFBS yielded a cost/benefit ratio of $1.00 to $8.05.

28. Further research required to: • Establish sustainability of outcomes - what are the long-term effects of IFBS on families? • Design and test step-down services especially for families with moderate or severe problems at case closure. • Identify factors involved when families do not remain intact.

29. Policy implications from IFBS research • High fidelity models of IFBS consistently show high success rates in US and NSW research studies. • Program fidelity matters. • Critical that KTS funding for family preservation enables genuinely intensive support.

30. Policy implications from IFBS research • Boston Consulting Group report on OOHC costs prepared for Community Services cause for concern. • Presents options for ↑ investment in intensive family preservation and restoration services BUT • Analysis based on significantly reduced unit costs for IFBS via a reduction in the caseworker ratio from 1:2 to 1:3.

31. Policy implications from IFBS research • Lack of transparency about what components are included in estimates of the wrap around services and administration costs per family. • No analysis of how changes in the IFBS caseworker ratio are likely to impact on rates of placement prevention and success rates for family restoration.

32. Thank you for listening • If you have any further questions please contact: